scholarly journals Systematic Evaluation of Systemic Right Ventricular Function

2019 ◽  
Vol 9 (1) ◽  
pp. 107
Author(s):  
Matthias Schneider ◽  
Matthias Beichl ◽  
Christian Nietsche ◽  
Dietrich Beitzke ◽  
Gerold Porenta ◽  
...  
Keyword(s):  
Adult Congenital Heart Disease ◽  
Cardiopulmonary Exercise Testing ◽  
Late Complications ◽  
Blood Analysis ◽  
3D Echocardiography ◽  
Systematic Evaluation ◽  
Longitudinal Function ◽  
Atrial Switch ◽  
The Right ◽  
2D And 3D

Background: The right ventricle serves as the subaortic systemic ventricle (sysRV) in patients with congenitally corrected transposition of the great arteries (ccTGA) and in patients with transposition of the great arteries (TGA) surgically repaired by an atrial switch. SysRV can lead to late complications, primarily heart failure, significant regurgitation of the systemic atrioventricular (AV) valve, and ventricular arrhythmias with sudden cardiac death. We sought to investigate the value of 2D- and 3D-echocardiographic parameters of sysRV function. Methods: Consecutive adult patients with sysRV who presented at the adult congenital heart disease outpatient clinic were prospectively enrolled. All patients received comprehensive transthoracic echocardiography, including 3D-echocardiography, cardiac magnetic-resonance-imaging (CMR), cardiopulmonary-exercise-testing, and blood analysis for NT-proBNP. Results. A total of 27 patients were included, 18 with TGA and nine with ccTGA. Median age was 37 years (Q1 = 31, Q3 = 44), 44% were male, median NT-proBNP was 189 pg/mL (Q1 = 155, Q3 = 467); sufficient 3D-echocardiography datasets were acquired in 78% of patients. All echocardiographic 2D and 3D volumetric function parameters correlated with CMR data, whereas a correlation was not seen with any of the longitudinal function parameters. NT-proBNP correlated with tricuspid annular plane systolic excursion (r = −0.43, p = 0.02) and CMR ejection fraction (EF) (r = −0.62, p = 0.003). Conclusion: Systematic evaluation of sysRV is complex and should include not only volumetric parameters but also parameters of longitudinal function in addition to measurement of NT-proBNP. In patients with good image quality, 3D-echocardiography can be used to assess volumes and EF.

scholarly journals Biventricular reverse remodeling and relationship with mitralvalve prolapse after transcatheter closure of ASD secundum, a 3Dechocardiographic study

2019 ◽  
Vol 12 (1) ◽  
pp. 15-19
Author(s):  
Amal El-Sisi ◽  
Shaheen Dabour ◽  
Aya M Fattouh ◽  
Effat Assar ◽  
Rasha Naguib ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Transcatheter Closure ◽  
3D Echocardiography ◽  
Reverse Remodeling ◽  
2D Echocardiography ◽  
Before And After ◽  
The Right ◽  
2D And 3D

Introduction: Mitral valve prolapse (MVP) is the most common anomaly of the mitral valve. Several studies have shown prevalence of MVP in atrial septal defect (ASD) especially secundum types (II). The aims of this study is to show the potential role of 3D echocardiography in improving the diagnosis of MVP and to depict the relationship between reverse remodeling of the right and left ventricles (RV, LV) and MVP after transcatheter closure of ASD II. <br /> Methods: Sixty patients underwent transcatheter closure of ASD II and completed follow up by 2D and 3D echocardiography in Cairo University Children Hospital before the procedure and at 24 hours, 1 and 6 months after the procedure.<br /> Results: 3D echocardiography was more accurate than 2D echocardiography in detecting MVP frequency in ASD II patients (75% vs. 50%). Maximum statistically significant remodeling was detected by 3D echocardiography 1 month after the procedure (RV: LV ratio by 3D echocardiography 1.9±0.03 24 hours after the procedure vs. 1.6±0.03 1 months after the procedure, P <0.01) while 2D echocardiography was delayed in detecting biventricular reverse remodeling. 3D derived RV: LV ratio was accurate in detecting MVP status with a sensitivity of 88%.<br /> Conclusion: MVP in ASD II may be related to Biventricular remodeling; 3D echocardiography is accurate in the detection of reverse remodeling as well as MVP in ASD II patients before and after device closure.

scholarly journals Cardiopulmonary Exercise Testing—A Valuable Tool, Not Gatekeeper When Referring Patients With Adult Congenital Heart Disease for Transplant Evaluation

2019 ◽  
Vol 10 (3) ◽  
pp. 286-291 ◽  
Author(s):  
Jonathan N. Menachem ◽  
Nosheen Reza ◽  
Jeremy A. Mazurek ◽  
Danielle Burstein ◽  
Edo Y. Birati ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Exercise Testing ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Consumption ◽  
Cardiopulmonary Exercise ◽  
Advanced Therapies ◽  
Adult Congenital

Introduction: Treatment of patients with adult congenital heart disease (ACHD) with advanced therapies including heart transplant (HT) is often delayed due to paucity of objective prognostic markers for the severity of heart failure (HF). While the utility of Cardiopulmonary Exercise Testing (CPET) in non-ACHD patients has been well-defined as it relates to prognosis, CPET for this purpose in ACHD is still under investigation. Methods: We performed a retrospective cohort study of 20 consecutive patients with ACHD who underwent HT between March 2010 and February 2016. Only 12 of 20 patients underwent CPET prior to transplantation. Demographics, standard measures of CPET interpretation, and 30-day and 1-year post transplantation outcomes were collected. Results: Patient Characteristics. Twenty patients with ACHD were transplanted at a median of 40 years of age (range: 23-57 years). Of the 12 patients who underwent CPET, 4 had undergone Fontan procedures, 4 had tetralogy of Fallot, 3 had d-transposition of the great arteries, and 1 had Ebstein anomaly. Thirty-day and one-year survival was 100%. All tests included in the analysis had a peak respiratory quotient _1.0. The median peak oxygen consumption per unit time (_VO2) for all diagnoses was 18.2 mL/kg/min (46% predicted), ranging from 12.2 to 22.6. Conclusion: There is a paucity of data to support best practices for patients with ACHD requiring transplantation. While it cannot be proven based on available data, it could be inferred that outcomes would have been worse or perhaps life sustaining options unavailable if providers delayed referral because of the lack of attainment of CPET-specific thresholds.

scholarly journals An Unusual Presentation of Pyelonephritis: Is It COVID-19 Related?

2021 ◽  
Author(s):  
L. J. van ‘t Hof ◽  
L. Pellikaan ◽  
D. Soonawala ◽  
H. Roshani
Keyword(s):  
Late Onset ◽  
Blood Clot ◽  
Time Frame ◽  
Venous Occlusion ◽  
Late Complications ◽  
Organ Injury ◽  
Vein Thrombosis ◽  
Lower Back ◽  
The Right ◽  
Renal Infection

AbstractIn severe cases of COVID-19, late complications such as coagulopathy and organ injury are increasingly described. In milder cases of the disease, the exact time frame and causal path of late-onset complications have not yet been determined. Although direct and indirect renal injury by SARS-CoV-2 has been confirmed, hemorrhagic renal infection or coagulative problems in the urinary tract have not yet been described. This case report describes a 35-year-old female without relevant medical history who, five days after having recovered from infection with SARS-CoV-2, had an unusual course of acute pyelonephritis of the right kidney and persistent fever under targeted antibiotic treatment. A hemorrhagic ureteral obstruction and severe swollen renal parenchyma preceded the onset of fever and was related to the developing pyelonephritis. Sudden thrombotic venous occlusion in the right eye appeared during admission. Symmetrical paresthesia in the limbs in combination with severe lower back pain and gastro-intestinal complaints also occurred and remained unexplained despite thorough investigation. We present the unusual combination of culture-confirmed bacterial hemorrhagic pyelonephritis with a blood clot in the proximal right ureter, complicated by retinal vein thrombosis, in a patient who had recovered from SARS-CoV-2-infection five days before presentation. The case is suspect of a COVID-19-related etiology.

scholarly journals The right ventricle shows distinct wall motion characteristics in L-TGA vs. D-TGA/atrial switch

2009 ◽  
Vol 11 (S1) ◽  
Author(s):  
Michelle Savacool ◽  
Philip Kilner ◽  
David Sahn ◽  
Willem Helbing ◽  
Harold Litt ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Wall Motion ◽  
Atrial Switch ◽  
Motion Characteristics ◽  
The Right

scholarly journals Improvement of the Impact Properties of Composite Laminates by Means of Nano-Modification of the Matrix—A Review

2018 ◽  
Vol 8 (12) ◽  
pp. 2406 ◽  
Author(s):  
Hamed Saghafi ◽  
Mohamad Fotouhi ◽  
Giangiacomo Minak
Keyword(s):  
Composite Laminates ◽  
Cost Effective ◽  
Careful Consideration ◽  
Impact Performance ◽  
Compression After Impact ◽  
The Matrix ◽  
The Right ◽  
2D And 3D ◽  
The Impact ◽  
Selection Of

This paper reviews recent works on the application of nanofibers and nanoparticle reinforcements to enhance the interlaminar fracture toughness, to reduce the impact induced damage and to improve the compression after impact performance of fiber reinforced composites with brittle thermosetting resins. The nanofibers have been mainly used as mats embedded between plies of laminated composites, whereas the nanoparticles have been used in 0D, 1D, 2D, and 3D dimensional patterns to reinforce the matrix and consequently the composite. The reinforcement mechanisms are presented, and a comparison is done between the different papers in the literature. This review shows that in order to have an efficient reinforcement effect, careful consideration is required in the manufacturing, materials selection and reinforcement content and percentage. The selection of the right parameters can provide a tough and impact resistant composite with cost effective reinforcements.

scholarly journals 2D IPO's for Constant Speed Lines, Curves, NURBS

2019 ◽  
Author(s):  
Valere Huypens
Keyword(s):  
Major Axis ◽  
Pulse Method ◽  
Constant Speed ◽  
Sampled Data ◽  
Reference Pulse ◽  
Production Manager ◽  
Definition Of ◽  
The Right ◽  
2D And 3D ◽  
Better Than

<div>Current constant speed IPO's, usually, use Sampled-data IPO's and constant speed lines use the </div><div>wrong initialized software DDA-ipo's, which make these IPO's unusable. The Bresenham- and </div><div>midpoint IPO's are non-constant speed reference pulse IPO's with bounded inaccuracy.</div><div>By adding an ultra-fast 3-lines algorithm "PRM-cs" to the actual midpoint or Bresenham algorithms, </div><div>we convert these midpoint-ipo's to very fast, constant speed, reference pulse IPO's. </div><div>This applies to 2D-lines, 3D-lines, 2D-curves and 2D-NURBS.</div><div>The PRM-cs measures, in real-time, the length of the discrete curve and the PRM-cs is completely new. </div><div>We define the best IPO, the major axis principle and the LSD-priority. </div><div>The major axis principle holds for the actual 3D-line IPO's. These IPO's are, generally, inaccurate, </div><div>but they can be updated to constant speed 3D-line IPO's, when the production manager agrees.</div><div>The Digital Geometric Geometry (DAG) defines the discrete lines globally, but this global </div><div>definition of a discrete 3D-line, gives discrete 3D-lines whose accuracy is much less than the </div><div>accuracy of the best discrete 3D-lines (e.g. 37% worse).</div><div>We describe the three causes of the inaccurate (imperfect) discrete 3D-lines. </div><div>All existing pulse-rate or PRM-ipo's use a wrong initialization, which deteriorates the accuracy. </div><div>We determine the right initialization for the new PRM-cs and the updated PRM-ipo. </div><div>We propose the benchmark-ipo "listSIM-ipo". This constant speed IPO can, also, be used in real-</div><div>time for every 2D- and 3D-curve. </div><div>The 3rd-degree Trident NURB shows that the constant speed reference pulse method is much </div><div>better than the existing sampled-data methods.</div>

Subdural false twins: concomitant appearance of subdural haematoma and spontaneous subdural empyema

2021 ◽  
Vol 14 (6) ◽  
pp. e240110
Author(s):  
Rúben Santos Cardoso ◽  
Sofia Tavares ◽  
Inácio Reis ◽  
José Luís Alves
Keyword(s):  
Multidisciplinary Approach ◽  
Systemic Infection ◽  
Blood Analysis ◽  
Surgical Drainage ◽  
Subdural Collection ◽  
E Coli ◽  
History Of ◽  
The Right ◽  
Burr Holes ◽  
Dural Opening

A 55-year-old man was taken to the emergency department due to right arm weakness for the past 3 days and fever (39.5°C). There was no impaired consciousness, no history of trauma and meningeal signs were absent on physical examination. Blood analysis and inflammatory markers were not evocative of a systemic infection. A cranial CT scan was requested, revealing hypodense bilateral hemispheric subdural collections, suggestive of chronic subdural haematomas. He was submitted to surgical drainage by burr holes, which confirmed the chronic subdural collection on the left side. Unexpectedly, after dural opening on the right side, a subdural purulent collection was found, which was later confirmed as an empyema due to Escherichia coli infection. A second surgical drainage was performed by craniotomy due to recurrence of the right subdural collection. Spontaneously appearing subdural empyemas due to E. coli are extremely rare and their treatment is not always straightforward. The reported case is an example of an apparently straightforward and frequent pathology that turned out to be a challenging case, requiring a multidisciplinary approach.

Adult congenital heart disease

2020 ◽  
pp. 225-254
Author(s):  
Andrew Hilton
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Anatomical Variation ◽  
Critically Ill Patient ◽  
Crista Terminalis ◽  
Echocardiographic Examination ◽  
Adult Congenital ◽  
The Right

The prevalence of congenital heart disease (CHD) in adults is increasing and many of these are likely to be admitted to the intensive care unit (ICU). Some of these patients may have undiagnosed CHD, usually relatively simple lesions such as atrial and ventricular septal defects. Occasionally, these may be more complex lesions (e.g. Ebstein’s anomaly) that even if unrecognized earlier in life can still allow survival into adulthood. Whether simple or complex, CHD can complicate the management of the critically ill patient, particularly if shunting or heart failure is present. The critical care echocardiographer is required to both recognize both normal anatomical variation and definite abnormal structural abnormalities in the adult patient. The aim of this chapter is to familiarize the echocardiographer with common anatomical variants, such as remnants of the right valve of the sinus venosus and crista terminalis, and present a careful and systematic approach to echocardiographic examination that may reliably identify relatively simple undiagnosed CHD in the adult.

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